Pain and Pain Experience

The concepts of placebos and placebo effects refer to extremely diverse phenomena. I recommend dissolving the concepts of placebos and placebo effects into loosely-related groups of specific mechanisms, including (potentially among others) expectation-fulfillment, classical conditioning, and attentional-somatic feedback loops. If this approach is on the right track, it has three main implications for the ethics of informed consent. First, because of the expectation-fulfillment mechanism, the process of informing cannot be considered independently from the potential effects of treatment. Obtaining informed consent (...) influences the effects of treatment. This provides support for the authorized concealment and authorized deception paradigms, and perhaps even for outright deceptive placebo use. Second, doctors may easily fail to consider the potential benefits of conditioning, leading them to misjudge the trade-off between beneficence and autonomy. Third, how attentional-somatic feedback loops play out depends not only on the content of the informing process but also on its framing. This suggests a role for libertarian paternalism in clinical practice. (shrink)

Accounts of the nature of unpleasant pain have proliferated over the past decade, but there has been little systematic investigation of which of them can accommodate its badness. This paper is such a study. In its sights are two targets: those who deny the non-instrumental disvalue of pain's unpleasantness; and those who allow it but deny that it can be accommodated by the view—advanced by me and others—that unpleasant pains are interoceptive experiences with evaluative content. Against the former, I argue (...) that pain's unpleasantness does indeed have noninstrumental disvalue; against the latter I argue both that my critics’ own desire-theoretic accounts of pain's unpleasantness cannot accommodate such disvalue, and that my evaluativist view can—either by appealing to “anti-unpleasantness” desires or by exploiting pain's perceptuality. (shrink)

Evaluativism is best thought of as a way of enriching a perceptual view of pain to account for pain’s unpleasantness or painfulness. Once it was common for philosophers to contrast pains with perceptual experiences (McGinn 1982; Rorty 1980). It was thought that perceptual experiences were intentional (or content-bearing, or about something), whereas pains were representationally blank. But today many of us reject this contrast. For us, your having a pain in your toe is a matter not of your sensing “pain-ly” (...) or encountering a sense-datum, but of your having an interoceptive experience representing (accurately or inaccurately) that your toe is in a particular experience-independent condition, such as undergoing a certain “disturbance” or being damaged or in danger (Armstrong 1962; Tye 1995). But even if such representational content makes an experience a pain, a further ingredient seems required to make the pain unpleasant. According to evaluativism, the further ingredient is the experience’s possession of evaluative content: its representing the bodily condition as bad for the subject. In this chapter, I elaborate evaluativism, locate it among alternatives, and explain its attractions and challenges. (shrink)

In various papers, Colin Klein has argued that pain experiences are commands. This monograph goes well beyond the papers, re-shaping his ‘imperativist’ view, setting it within a general account of ‘homeostatic sensations’, presenting new arguments, and criticising alternatives. Original, empirically informed, clear, and often persuasive, it is a lovely book.

Sometimes the philosophical armchair gets bumped by empirical facts. So it is when thinking about pain. For good or ill (good, actually, as we shall see) most of us are intimately acquainted with physical pain, the kind you feel when you stand on a nail or burn your hand. And, from the armchair, it can seem blindingly obvious that pain is essentially unpleasant. There are of course unpleasant experiences that aren’t pains – nausea or itches, for example – but surely (...) there aren’t pains that don’t hurt, pains that are neutral or even pleasurable rather than unpleasant. Surely, indeed, there couldn’t be. For it is part of the very concept of a pain that a pain be unpleasant. Or so it has seemed to many. Yet over recent decades philosophers’ confidence in these putative truisms has been shaken by some fascinating cases from the clinic, the lab, and life. (shrink)

Philosophers think of pain less and less as a paradigmatic instance of mentality, for which they seek a general account, and increasingly as a rich and fruitful topic in its own right. Pain raises specific questions: about mentality and consciousness certainly, but also about embodiment, affect, motivation, and value, to name but a few. The growth of philosophical interest in pain has gone hand-in-hand with the growth of pain science, which burgeoned in the 1960s. This is no accident: developments in (...) pain science have prompted philosophers to take account of empirical data, and to revisit their assumptions about pain. Pain, in short, demands interdisciplinary investigation, hence while this entry focuses on the philosophy of pain, it makes liberal reference to empirical literature along the way. This entry’s focus is on physical pains, that is pains that are felt in bodily locations, not emotional suffering more broadly, such as grief or disappointment. The entry also does not address pain’s place in ethical theories; its focus is rather on issues that arise within philosophy of mind. Even so, part of what makes pain such an interesting and important topic is that the questions it raises span boundaries, and normative questions concerning pain’s badness, on the one hand, and its value, on the other, are never far away. (shrink)

Pain asymbolia is a rare condition caused by brain damage, usually in adulthood. Asymbolics feel pain but appear indifferent to it, and indifferent also to visual and verbal threats. How should we make sense of this? Nikola Grahek thinks asymbolics’ pains are abnormal, lacking a component that make normal pains unpleasant and motivating. Colin Klein thinks that what is abnormal is not asymbolics’ pains, but asymbolics: they have a psychological deficit making them unresponsive to unpleasant pain. I argue that an (...) illuminating account requires elements of both views. Asymbolic pains are indeed abnormal, but they are abnormal because asymbolics are. I agree with Klein that asymbolics are incapable of caring about their bodily integrity; but I argue against him that, if this is to explain not only their indifference to visual and verbal threat, but also their indifference to pain, we must do the following: (i) take asymbolics’ lack of bodily care not as an alternative to, but as an explanation of their pains’ missing a component, and (ii) claim that the missing component consists in evaluative content. Asymbolia, I conclude, reveals not only that unpleasant pain is composite, but that its ‘hedomotive component’ is evaluative. (shrink)

The unpleasantness of pain motivates action. Hence many philosophers have doubted that it can be accounted for purely in terms of pain’s possession of indicative representational content. Instead, they have explained it in terms of subjects’ inclinations to stop their pains, or in terms of pain’s imperative content. I claim that such “noncognitivist” accounts fail to accommodate unpleasant pain’s reason-giving force. What is needed, I argue, is a view on which pains are unpleasant, motivate, and provide reasons in virtue of (...) possessing content that is indeed indicative, but also, crucially, evaluative. (shrink)

Pain, crucially, is unpleasant and motivational. It can be awful; and it drives us to action, e.g. to take our weight off a sprained ankle. But what is the relationship between pain and those two features? And in virtue of what does pain have them? Addressing these questions, Colin Klein and Richard J. Hall have recently developed the idea that pains are, at least partly, experiential commands—to stop placing your weight on your ankle, for example. In this paper, I reject (...) their accounts. Against Klein, I use dissociation cases to argue that possession of ‘imperative content’ cannot wholly constitute pain. Against them both, I further claim that possession of such content cannot even constitute pain’s unpleasant, motivational aspect. For, even if it were possible to specify the relevant imperative content—which is far from clear—the idea of a command cannot bear the explanatory weight Klein and Hall place on it. (shrink)

Our preoccupation with pain can seem an eccentricity of philosophers. But just a little reflection leads one into the thickets. When I see a pencil on my desk, I’m aware of a physical thing and its objective properties; but what am I aware of when I feel a pain in my toe? A pain, perhaps? Or my toe’s hurting? But what is the nature of such things? Are they physical? Are they objective? To avoid unexperienced pains, we might say they (...) are subjective, or are themselves experiences. But do those with hurting toes therefore have experiences in their feet? The issues rapidly proliferate. Many of them are addressed in this interesting collection of original essays by philosophers, psychologists, and neuroscientists, edited by Murat Aydede. (shrink)

It can seem natural to say that, when in pain, we undergo experiences which present to us certain experience-dependent particulars, namely pains. As part of his wider approach to mind and world, John McDowell has elaborated an interesting but neglected version of this account of pain. Here I set out McDowell’s account at length, and place it in context. I argue that his subjectivist conception of the objects of pain experience is incompatible with his requirement that such experience be presentational, (...) rationalizing, and classificatory. (shrink)

Perceptualists say that having a pain in a body part consists in perceiving the part as instantiating some property. I argue that perceptualism makes better sense of the connections between pain location and the experiences undergone by people in pain than three alternative accounts that dispense with perception. Turning to fellow perceptualists, I also reject ways in which David Armstrong and Michael Tye understand and motivate perceptualism, and I propose an alternative interpretation, one that vitiates a pair of objections—due to (...) John Hyman—concerning the meaning of ‘Amy has a pain in her foot’ and the idea of bodily sensitivity. Perceptualism, I conclude, remains our best account of the location of pains. (shrink)

Compare your pain when immersing your hand in freezing water and your pleasure when you taste your favourite wine. The relationship seems obvious. Your pain experience is unpleasant, aversive, negative, and bad. Your experience of the wine is pleasant, attractive, positive, and good. Pain and pleasure are straightforwardly opposites. Or that, at any rate, can seem beyond doubt, and to leave little more to be said. But, in fact, it is not beyond doubt. And, true or false, it leaves a (...) good deal more to be said: about the nature of sensory affect; its relations to perception, motivation, and rationality; its value; and the mechanisms underlying it. Much is said about these matters in the contributions that follow. Here, in this introductory essay, we map the dialectical landscape and locate our contributors’ papers within it. (shrink)

Over recent decades, pain has received increasing attention as – with ever greater sophistication and rigour – theorists have tried to answer the deep and difficult questions it poses. What is pain’s nature? What is its point? In what sense is it bad? The papers collected in this volume are a contribution to that effort ...

Is a phenomenal pain a conscious primitive or composed of more primitive phenomenal states? Are pain experiences necessarily or only contingently unpleasant? Here, I sketch how to answer such questions concerning intra-phenomenal metaphysics using the example of pain and unpleasantness. Arguments for a symmetrical metaphysical independence of phenomenal pain and unpleasant affect are presented, rejecting a composite view like the IASP definition and dimensional views. The motivating intuition of these views is explained by common binding mechanisms in consciousness and characterized (...) as fallacious if generalized. There are, however, underlying commonalities between pain perception and unpleasant affect, e.g. formal content or evolutionary ancestry. (shrink)

Can we find necessary and sufficient conditions for a mental state to be a pain state? That is, does pain have a nature? Or is the term ‘pain’ ambiguous? I argue here that our expression ‘pain’ lacks necessary use conditions if one considers a range of contexts. As use conditions constrain the reference class, I argue that ‘pain’ does not refer to a natural category, but binds together a bunch of loosely resembling phenomena. This leads to problems for scientific and (...) clinical discourse. To solve these, a method of explication is suggested, based on a discursive combination between analysis of first-person reports and theories of natural science. Lastly, I consider the ethical implications of this ambiguity that lead to a reformulation of the goal of pain science: Not alleviation of all pains ought to be our goal, but only manipulation of conscious and negatively emotionally charged pains. (shrink)

I argue that an analogy between pains and sounds suggests a way to give an objective account of pain which fits well with a naïve perceptualist account of feeling pain. According to the proposed metaphysical account, pains are relational physical events with shared qualitative nature, each of which is constituted by tissue damage and the activation of nociceptors. I proceed to show that the metaphysical proposal is compatible with platitudes about pains being animate, private, and self-intimating states.

Poniższe analizy są tylko i wyłącznie mojego autorstwa. Nie korzystałem z żadnych komentarzy. To, co odnalazłem, jest jednak całkiem inne niż większość przypuszcza. Z uwagi na cenzurę panującą w katolickich wydawnictwach, w portalach, ten tekst również został opublikowany w internecie, tam, gdzie myśl ludzka ma swobodny przepływ. -/- W niniejszym artykule pragnę podzielić się przemyśleniami dotyczącymi królestwa Jezusa, dokładniej zaś chodzi o część tego stwierdzenia, które obecne jest w teologii od zawsze. Czytamy: „Jest tylko jeden...bez początku: to Bóg, który nigdy (...) nie zaczął istnieć, gdyż był zawsze” W tym cytacie, który jest w pewnym sensie kalką z nauki filozofów eleatów żyjących przed Jezusem, analizować będę „bez początku”. (shrink)

It is widely held that it is only contingent that the sensation of pain is disliked, and that when pain is not disliked, it is not intrinsically bad. This conjunction of claims has often been taken to support a subjectivist view of pain’s badness on which pain is bad simply because it is the object of a negative attitude and not because of what it feels like. In this paper, I argue that accepting this conjunction of claims does not commit (...) us to this subjectivist view. They are compatible with an objectivist view of pain’s badness, and with thinking that this badness is due to its phenomenal quality. Indeed, I argue that once the full range of options is in view, the most plausible account of pain is incompatible with subjectivism about value. (shrink)

This chapter (from Routledge's forthcoming handbook on the philosophy of pain) considers the question of whether people are always correct when they judge themselves to be in pain, or not in pain. While I don't show sympathy for traditional routes to the conclusion that people are "incorrigible" in their pain judgments, I explore--and perhaps even advocate--a different route to such incorrigibility. On this low road to incorrigibility, a sensory state's being judged unpleasant is what makes it a pain (or not).

Imperativism is the view that the phenomenal character of the affective component of pains, orgasms, and pleasant or unpleasant sensory experience depends on their imperative intentional content. In this paper I canvass an imperativist treatment of pains as reason-conferring states.

Recent work on signaling has mostly focused on communication between organisms. The Lewis–Skyrms framework should be equally applicable to intra-organismic signaling. We present a Lewis–Skyrms signaling-game model of painful signaling, and use it to argue that the content of pain is predominantly imperative. We address several objections to the account, concluding that our model gives a productive framework within which to consider internal signaling.

This chapter defends an axiological theory of pain according to which pains are bodily episodes that are bad in some way. Section 1 introduces two standard assumptions about pain that the axiological theory constitutively rejects: (i) that pains are essentially tied to consciousness and (ii) that pains are not essentially tied to badness. Section 2 presents the axiological theory by contrast to these and provides a preliminary defense of it. Section 3 introduces the paradox of pain and argues that since (...) the axiological theory takes the location of pain at face value, it needs to grapple with the privacy, self-intimacy and incorrigibility of pain. Sections 4, 5 and 6 explain how the axiological theory may deal with each of these. (shrink)

What is the contrary of pleasure? “Pain” is one common answer. This paper argues that pleasure instead has two natural contraries: unpleasure and hedonic indifference. This view is defended by drawing attention to two often-neglected concepts: the formal relation of polar opposition and the psychological state of hedonic indifference. The existence of mixed feelings, it is argued, does not threaten the contrariety of pleasure and unpleasure.

It is widely thought that functionalism and the qualia theory are better positioned to accommodate the ‘affective’ aspect of pain phenomenology than representationalism. In this paper, we attempt to overturn this opinion by raising problems for both functionalism and the qualia theory on this score. With regard to functionalism, we argue that it gets the order of explanation wrong: pain experience gives rise to the effects it does because it hurts, and not the other way around. With regard to the (...) qualia theory, we argue that it fails to capture the sense in which pain 's affective phenomenology rationalises various bodily-directed beliefs, desires, and behaviours. Representationalism, in contrast, escapes both of these problems: it gets the order of explanation right and it explains how pain 's affective phenomenology can rationalise bodily-directed beliefs, desires, and behaviours. For this reason, we argue that representationalism has a significant advantage in the debates about pain 's affective phenomenology. We end the paper by examining objections, including the question of what representationalists should say about so-called ‘disassociation cases’, such as pain asymbolia. (shrink)

will give an overview of the fascinating communication between G. W. Leibniz and Pierre Bayle on pre-established harmony and sudden change in the soul which started from Bayle’s footnote H to the article “Rorarius” in his Dictionnaire historique et critique (1697) and ended in 1706 with Bayle’s death. I will compare the views presented in the communication to Leibniz’s reflections on the soul in his partly concurrent Nouveaux essais sur l’entendement humain (1704) and argue that many topics in the communication (...) with Bayle are discussed with more details in Nouveaux essais. I also argue that the communication helped Leibniz to respond to Locke’s views concerning uneasiness in An Essay Concerning Human Understanding, II, xxi. Bayle himself, however, was not able to completely understand Leibniz’s views on spontaneity as he was unaware of the contents of the Nouveaux essais, especially the systematic role of petites perceptions in Leibniz’s philosophy of mind. I will also reflect on whether the controversy could have ended in agreement if it would have continued longer. (shrink)

Functionalism of robot pain claims that what is definitive of robot pain is functional role, defined as the causal relations pain has to noxious stimuli, behavior and other subjective states. Here, I propose that the only way to theorize role-functionalism of robot pain is in terms of type-identity theory. I argue that what makes a state pain for a neuro-robot at a time is the functional role it has in the robot at the time, and this state is type identical (...) to a specific circuit state. Support from an experimental study shows that if the neural network that controls a robot includes a specific 'emotion circuit', physical damage to the robot will cause the disposition to avoid movement, thereby enhancing fitness, compared to robots without the circuit. Thus, pain for a robot at a time is type identical to a specific circuit state. (shrink)